Roula Khalaf, Editor of the Financial Times, curates her favorite stories in this engaging weekly newsletter. Among the most pressing issues examined is the significant strain placed on the National Health Service (NHS) by an ageing population, particularly at the University Hospitals of Leicester trust.

Projected trends indicate that within the next decade, the population of older individuals in Leicester, Leicestershire, and Rutlanda region located in England's East Midlandswill expand at a staggering rate of three times that of the general population. This demographic shift poses a formidable challenge for healthcare providers, especially as they strive to meet the demands of a frail population.

At the helm of this crucial healthcare facility is Richard Mitchell, the chief executive of the trust, who manages the busiest emergency department in the country located at the Leicester Royal Infirmary. The pressure on his team is palpable; currently, the emergency department sees around 20,000 patient visits each month. Alarmingly, patient attendances have surged by 6 percent over the past year, while admissions have risen by an even steeper 11 percent.

In an effort to address this escalating demand for healthcare services, the hospital has initiated a new approach tailored specifically for the needs of older patients. The newly established Frailty Same Day Emergency Care (SDEC) Unit aims to provide swift, specialized assessment for older individuals arriving at the emergency department, thereby freeing up essential bed space for those who require immediate hospitalization.

Mitchell emphasized the pressing need for reform in community care services, stating, Far too many people who should be treated by local services are ending up in the emergency department due to insufficient community capacity. He elaborated that the emergency department, while operational 24/7, often becomes the only viable option for patients, particularly the elderly living with frailty. What we are witnessing is an escalating demand at our front door, he added, underscoring the urgent need for change in the healthcare system.

Christopher Miller, who plays a pivotal role in managing the pilot unit that commenced operations in January, reported significant improvements in patient outcomes. By utilizing this unit, we are saving patients many days usually spent in a hospital, Miller remarked. Being stuck in the emergency department for up to 24 hours, possibly on a trolley, is not conducive to patient well-being. Data indicates that since its launch, the unit has assessed 408 frail patients, of whom 305 were discharged without requiring hospital admission. Remarkably, 71 percent of those patients were sent home within 24 hours of their arrival.

The unit is also receiving direct referrals from local GP surgeries and community hospitals, a strategic move designed to keep patients out of the congested emergency room environment. The NHS mandates that hospitals with 24-hour emergency services should maintain an Acute Frailty service for a minimum of 70 hours each week. However, financial constraints have left many hospitals unable to implement this essential service. As of now, Leicester's staff are uncertain whether they will secure the funding necessary to establish the pilot as a permanent fixture.

Newly appointed consultant geriatrician Ruw Abeyratne, who serves as the trusts first director of health equality and inclusion, echoed these sentiments. I encountered several patients just yesterday who absolutely didnt need to be hospitalized to receive care, Abeyratne noted, highlighting the systemic issues present within the healthcare framework. The challenge lies in ensuring that we have the right professionals available in the community, but we currently lack the necessary resources, both in terms of personnel and funding.

As the population ages, projections suggest that the proportion of individuals aged over 85 in the UK will nearly double from 2.5 percent to 4.3 percent between mid-2022 and mid-2047. This impending demographic shift has not gone unnoticed by policymakers.

An analysis by the Nuffield Trust think-tank revealed that one in ten patients aged 80 or older who were not ultimately admitted to the hospital waited more than 12 hours in A&E, reflecting the growing strain on emergency services. In response, the governments forthcoming 10-year plan for the NHS, expected to be unveiled in the spring, will likely place a strong emphasis on frailty, with a focus on redesigning services to better cater to this demographic outside hospital settings. This could lead to an increase in the number of GPs, district nurses, and pharmacies available to provide care in community settings.

Health Secretary Wes Streeting has outlined three significant big shifts within the plan, one of which includes a commitment to transition more healthcare delivery away from hospitals and into community environments.

While Miller supports the idea of shifting towards more community-based care, he recognizes the challenges involved: The trouble is we dont have the right personnel in the right settings to deliver appropriate care elsewhere.

Despite these systemic obstacles, the SDEC unit aims to operate effectively in the face of increased demand from the growing population of elderly patients, although this endeavor comes with considerable financial implications. Data from 2022 indicates that 22 percent of patients with three or more chronic conditions accounted for a staggering 78 percent of the trust's acute hospital expenditures.

Dr. Chris Miller, the associate medical director for frailty, engaged with Diane Wright, an 89-year-old patient from Oadby, Leicester, who was admitted to A&E due to gastroenteritis and subsequently transferred to the SDEC unit. The patients you see in the unit are costing between 500 and 1,000 for treatment in an acute setting, Mitchell explained. If we can allocate them to appropriate community spaces, the cost could drop to between 200 and 300.

While the NHS boasts a multitude of services, they are often compartmentalized and challenging to navigate, even for clinicians working within the system. Nevertheless, for many patients, the pilot unit has offered a much-needed alternative to the lengthy waits typical of A&E.

Diane Wright, who was initially admitted to A&E, shared her experience, saying, I was really very poorly, but Ive received excellent care here in this unit. As you can see, the rooms are lovely. This environment is much more relaxed, and theyve been very good at providing information. This feedback reflects a wider sentiment of appreciation among patients who have benefitted from the innovative approach taken by the SDEC unit.

Data visualization by Amy Borrett.